N.H. Hospital Offers Deals On Procedures To Uninsured

Richard Coll saw an advertisement for a flat-rate colonoscopy in his local paper. (Todd Bookman/NHPR)

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Transparency and low cost aren’t exactly widespread when it comes to getting healthcare. But Elliot Hospital in Manchester, New Hampshire, is trying to change that.

The hospital is offering “CareBundles,” an all-inclusive fee for procedures like colonoscopies and knee surgery. At this time, only the uninsured can get fixed price procedures. But while the initiative is in its infancy, some big companies are making similar low-cost deals with hospitals in other parts of the country.

From the Here & Now Contributors Network, New Hampshire Public Radio’s Todd Bookman reports.

And if you don't have health insurance coverage, getting a price up front to figure out your medical treatment can be nearly impossible. But one New Hampshire hospital is trying to change that model. From the HERE AND NOW Contributors Network NHPR's Todd Bookman has the story.

TODD BOOKMAN, BYLINE: You don't drop everything to go get a colonoscopy. But after a decade of waiting, 63-year-old Richard Coll of Manchester knew he couldn't keep putting it off.

RICHARD COLL: It's something you got to do, you're supposed to do. There's a little bit of history in my family, so I was encouraged to do it.

BOOKMAN: But Coll doesn't have insurance, and the price tag - actually the lack of a price tag - kept getting in the way.

COLL: Shopping around, and everybody I asked, whether it was the doctor or an institution like a hospital, they just looked at me like I was crazy.

BOOKMAN: Coll is his own boss, a property manager. He prices out building materials, paint, lumber, all before purchasing. He couldn't understand why a colonoscopy didn't work the same way. Then earlier this year, he saw an advertisement in the Sunday paper - $2,000 paid up front at Elliot Hospital.

COLL: It was real easy. Just went in there, they put me to sleep and woke me up, and said, goodbye.

BOOKMAN: Coll should be happy; he got a clean bill of health and a good price. The Elliot is now offering colonoscopies, along with hernia repair or knee arthroscopy for one all-inclusive fee. It calls them CareBundles.

DR. RICK PHELPS: Understandably, everyone in America is frustrated by the lack of transparency in health care.

BOOKMAN: Dr. Rick Phelps is president of Elliot Hospital. He says the initiative is a way to inform patients.

PHELPS: I think that frustration has been exacerbated with all of the high-deductible health plans that are out there. So now we've created consumerism. The problem is we haven't armed the consumer with access to the information that they need to make smart decisions.

BOOKMAN: Transparency isn't widespread in health care, but it isn't exactly new to New Hampshire. In 2007, the state Insurance Department launched nhhealthcost.org, a little-marketed website that lists the prices of about 40 common procedures at hospitals around the state. In its infancy, the project offered something of a laboratory for how transparency could impact the cost of care.

TYLER BRANNEN: It does lead to a lot of follow-up questions, and one of them is whether or not the market would respond.

BOOKMAN: Tyler Brannen with the state's Insurance Department says researchers tracked nhhealthcost.org to see if prices changed after becoming public. That is, would some of the market variability be smoothed out by more transparency? Would hospitals that charge more for that colonoscopy be forced to lower their prices? The results, in the end, suggested otherwise.

BRANNEN: We did not see, essentially, the market responding.

BOOKMAN: Brannen says what is changing has more to do with how insurance companies design plans. Many now offer incentives, including reduced co-pays, if you use a preferred medical provider - one with lower prices but good quality. And some large employers are following a similar track. Wal-Mart, Lowe's and PepsiCo have struck deals with hospitals around the country, including the Mayo Clinic, where an employee's surgery can be performed with a fixed, known cost to the company.

Elliot Hospital hopes to launch similar relationships through its CareBundles. But for now, only the uninsured can get the set-price procedures, says Dr. Phelps.

PHELPS: In our disclaimer on our ad, the first word is regrettably. And I want to emphasize that. We truly regret at this moment that we don't have the capacity to offer these CareBundles to all employers, to all patients, to all insurers.

BOOKMAN: The barriers include the complicated web of contracts that bind hospitals, doctors and insurers, a system not easy to change. Phelps also says there are IT challenges to making the bundles work. But with ever-rising deductibles, even insured patients are pressuring the industry to put a clearer price on their care.

For HERE AND NOW, I'm Todd Bookman.

YOUNG: And you are listening to HERE AND NOW. Transcript provided by NPR, Copyright NPR.